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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 397005571
Report Date: 03/04/2025
Date Signed: 03/05/2025 11:26:50 AM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 03/05/2025 11:26 AM - It Cannot Be Edited
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:ENCLAVE AT THE DELTAFACILITY NUMBER:
397005571
ADMINISTRATOR/
DIRECTOR:
LO, SUSANFACILITY TYPE:
735
ADDRESS:4951 EIGHT MILE ROADTELEPHONE:
(209) 210-4863
CITY:STOCKTONSTATE: CAZIP CODE:
95212
CAPACITY: 45CENSUS: 44DATE:
03/04/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:12 AM
MET WITH:Tia PrestonTIME VISIT/
INSPECTION COMPLETED:
02:00 PM
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Licensing Program Analyst, (LPA) Albert Johnson arrived at this facility unannounced to conduct an annual inspection visit. LPA met with the Administrator Tia Preston and explained the purpose of the visit. Later joined by Momo Duoa.

LPA inspected the physical plant including but not limited to the kitchen, dining room, resident bedrooms; resident bathrooms, laundry room, living area, common areas, and outside perimeter of the facility to ensure compliance with Title 22 regulations. Facility is a 45 bed adult residential facility with a current census of 44.

The facility has an approved COVID Mitigation plan LIC 808 form in place. No obstructions to fire exits noted. LPA reviewed 10 resident files and 5 staff files. Staff files contained updated first aid/CPR training. Water temperature reads between 105*F and 120*F in the bathroom and room temperature reads 74*F. LPA observed the facility to have adequate food supply on hand. Resident rooms had the required furniture and furnishings. The facility common areas were furnished.

Fire extinguisher, smoke detector and carbon monoxide detector was operational . Last fire drill conducted 1/2025. Facility has an emergency food and water kit.

During the medication review LPA and Staff assisting observed controlled medication for R1 not documented as part of the centrally stored log. Also observed in the kitchen were toxins (Ecolab sanitizer uncover with a hose coming out to the system) in a food prep area. Advisory given

Per California Code of Regulations, Title 22, no deficiencies were cited during this visit.

Exit interview was held and a copy of this report was left at the facility

SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Albert Johnson
LICENSING EVALUATOR SIGNATURE: DATE: 03/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/04/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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